Discussions By Condition: I cannot get a diagnosis.

My 5 yr old has seen 4 doctors and still no answers.

Hi, I'm hoping someone may have some answers for me. My daughter just turned 5, Dec. 22. She is normally a very healthy, active child. I have 3 other daughters and none of them have had any of this, except for maybe some sniffles. I'm thinking if it is some weird virus that they would be ill too. Here is a time line I made up for the doctor, as we ended up seeing 4 so far from going to emergency & my family doctor.

Dec. 24 - A couple red spots appeared on face, off corner of right side of mouth.

Dec. 27 - Took her into the emergency room, spots had increased to about 15 - 20. They were on lower cheeks, chin and some on front of neck. Some were very red & inflamed looking. She had no fever or any other symptoms. They were a little itchy but Chicken pox was ruled out. Doctor didn’t know the cause.

Dec. 28 - Very little appetite all day, pale & tired looking. Spots increased a little, but never left the lower cheeks, chin and front neck.

Dec. 29 - Awoke at 5 a.m. vomiting & dry heaves. Took her back into emergency room. Dry heaves lasted until about 6:30 a.m. (approx. 30 times in that timeframe) Some spots on cheeks were very large and bright red….looked infected. She seemed tired and the spots were itchy. She vomited again around noon a few times. Still no fever or other symptoms. She was admitted overnight, they ran blood and urine tests….nothing showed except white cell count in blood was slightly elevated. They put calamine on her spots and gave her pedialyte. By late evening she ate and felt better. She was released next day.

Jan. 3 - Awoke at 3 a.m. complaining of sore legs while laying down and walking. She had a fever of 102 F. I administered Tylenol and she felt better by morning. Her spots were gone but her face was dry and chapped where we put the calamine. She has started having a runny nose & sneezing symptoms for a few days.

Jan. 9 (today)- Her face looks like she may have some spots coming back (small & faint looking & a little itchy) Took her into family doctor again and nothing showed out of the ordinary. He ordered blood tests for us to get done on Monday. She is complaining of being a little sore again (right side of neck, legs) She had 2 more bouts of loose bowel movements today (not watery though)

12 Replies:

Were you giving her unprescribed antibiotics? Amoxicillin, for instance, causes a rash in patients with mono. And I'm sorry for saying so, but I rather expect someone who takes their child to the emergency room for a non-emergency to also be giving their child unnecessary medications "just in case."more information please? blood test results (a little high white count would just mean she was a little sick... that's normal), etc?

No she was not or is not on any medications. I thought it could have been a bacterial infection starting (because they were so inflamed looking) but the doctors thought virus.(I don't think virus because no one else has been sick) Her white blood cell count was at 14.6 (normal is: 5 - 13)

Do the spots from the rash blanche when you press upon them or is there no difference in color? My initial impression at this point with a history of headache, leg pain when walking, elevated white count, vomiting, rash and a fever would be viral menningitis. Realize that unlike bacterial meningitis, viral meningitis runs a rather mild course, typically about a week to 14 days. While complications can develop, most infections are uneventful. The labs will not likely reveal much more than you already know. At this point, keep your doctor informed of any changes, particularly a worsening headache and stiffness in the neck. Best regards, J Cottle, MD

Do the spots from the rash blanche when you press upon them or is there no difference in color? My initial impression at this point with a history of headache, leg pain when walking, elevated white count, vomiting, rash and a fever would be viral menningitis. Realize that unlike bacterial meningitis, viral meningitis runs a rather mild course, typically about a week to 14 days. While complications can develop, most infections are uneventful. The labs will not likely reveal much more than you already know. At this point, keep your doctor informed of any changes, particularly a worsening headache and stiffness in the neck. Best regards, J Cottle, MD Thank you for your answer, I had mentioned Meningitis when I initially took her the second time with the vomiting. They didn't seem to think that was a possibility. I was nervous because she didn't get that vaccine, she was born right before they started to administer that vaccination. I will definitely try the spot test, if they seem to be recurring. I wish I had of thought of that when they were so bad. She was complaining of her neck before she went to bed tonight, but only on the right side. Would it be a worry just on one side? Thanks.

Well, the characteristics of viral meningitis can vary slightly between patients, but overall remember that the viral form is not associated with the same morbidity and morality as bacterial meningitis. The timeframe is about at its threshold, having initially thought to have transpired on December 24th, so the next few days will be critical in determining whether the virus is becoming non-pathological in her instance. These viruses have limited endurance. I would suggest that if the spots return to the more florid or widespread extent and her symptoms in general increase, then I'd return her promptly to be re-evaluated. This will likely self-resolve, however, and realize that post viral reactivation to a milder extent is not altogether uncommon in some patients. Again, close monitoring for signs of change will be the key at this point. Best regards, J Cottle, MD

Well, the characteristics of viral meningitis can vary slightly between patients, but overall remember that the viral form is not associated with the same morbidity and morality as bacterial meningitis. The timeframe is about at its threshold, having initially thought to have transpired on December 24th, so the next few days will be critical in determining whether the virus is becoming non-pathological in her instance. These viruses have limited endurance. I would suggest that if the spots return to the more florid or widespread extent and her symptoms in general increase, then I'd return her promptly to be re-evaluated. This will likely self-resolve, however, and realize that post viral reactivation to a milder extent is not altogether uncommon in some patients. Again, close monitoring for signs of change will be the key at this point. Best regards, J Cottle, MD Thank you for your quick reply.:) She awoke last night around 2 a.m. with sore neck and legs again, practically crying just to get up to go to the bathroom. She had no fever so I administered Tylenol again for the pain. An hour or so later she was finally asleep and she seems pretty good today. (Her lower back is a little sore - same as the last time she had the sore legs) The other thing that she has going on that I forgot to mention is horrible smelling flatulence. It's almost sour smelling, her sisters complain everytime she lets one go and it is very strong. I assume it's just related to the upset of her digestive tract from the loose bowel movements. What you have said does fit well, the spots are very faded that showed yesterday, so they have not escalated to the way they were a few weeks ago. Thank you very much for your help. If you have a chance I have two more questions for you: Would this show on a blood test, my doctor has the regular CBC ordered and the other one is CRP. Would this show under those or is there a certain test I can request? I have 3 more daughters: 10, 2 and 11 months, do I need to worry about them with this? They haven't been sick yet except some sniffles. Thank you very much:)

What about Rocky Mountain Spotted Fever? I don't live in the Rocky Mountains, but I got it from flea bites, and I had infected spots all over my face. Thank you for your suggestion, I did look at some pictures of this but her spots were not like those. Some of hers were large and some small. Some were very red (blood red) and some just pink. They seemed to have a small whitish center that went scaby when it started to dry up. Almost like chicken pox but she didn't get them anywhere but lower cheeks, chin and a few on the front of her neck. Plus hers were not extremely itchy like chicken pox.

While certain viral pathogens, such as the rotavirus, are an extremely common cause for diarrhea and vomiting in young children, it is also the case that diet changes rather dramatically in youngsters who feel ill that consequently restricts the diet to certain preferences that can be the cause of foul-smelling stools. Frank diarrhea and mild steatorrhea are typically associated with foul-smelling stools and gas production as well. It would not be of a concern at this point. When attempting to replace electrolytes, be certain that you use Pedialyte or similar product that has less sugar content than sports drinks, which are commonly used by persons with the notion of replacing electrolytes lost to vomiting and diarrhea. The high sugar content of these particular products can prolong and/or worsen diarrhea. In fact, any products high in sugar will typically yield poor results. Always insist on some extent of clear liquids like fresh water to prevent dehydration and combined with the Pedialyte or similar products, will typically yield the best results. It's fine to treat the aches and pains symptomatically using children's Tylenol or similar product, although we always caution to stay clear of aspirin products due to certain complications that can sometimes arise. The CBC is a fractionation of the red and white cells, together with platelets and although the white count might still be mildly elevated, I would otherwise expect the other studies to be unremarkable. The CRP, or C-reactive protein, tells us whether inflammation of a general nature is present and to what extent. While some physicians mistakingly regard this lab test to be rather specific, it is actually just more of a screen. It could possibly be elevated in her case, but I would find such results to be somewhat expected in this case and really wouldn't suggest anything further at this point than what the child is already demonstrating in the way of clinical signs of illness. Again, this is a case that while having demonstrated mild reactivation symptoms, is likely going to self-resolve within another 48 hours or so, but expect that she might continue to feel washed out for another 4 or 5 days. I think she's going to be fine. Lastly, a simple reminder that if symptoms change or worsen, prompt medical attention is advised. Best regards, J Cottle, MD

I just wanted to thank you. We never did find out exactly what she has been sick with but she has been continually feeling better...it's been a long 3 weeks! She is still pasty but her appetite is returning and the other symptoms have gone. We did get numerous blood tests done on Monday and they came back okay. Now the only problem is my 2 1/2 year old started vomiting this morning. Not sure if she is coming down with the same thing but 3 weeks is a long gestation period. Just wanted to let everyone know that things seem better. Thanks!:)

Not sure if she is coming down with the same thing but 3 weeks is a long gestation period. LOL.....I meant to say incubation period! Now today my 2 year old is starting to get a few spots on her face. So I guess it must be a virus.

Has your daughter been checked for Mono. My DD had it last year. It was six months of sheer he$$. What led the Dr's to a dx was the red dots on her face they were in vertical lines. The doctors found it highly unusual that she got it at her age. It would be worth the blood test. Apparently there has been a really bad strain of it going around. DD had it once and I am on my 2nd round of it. Hope your daughter gets some relief soon. t